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PLoS One. 2019 May 15;14(5):e0216680. doi: 10.1371/journal.pone.0216680. eCollection 2019.

HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia.

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Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
Department of Statistics, University of California Davis, Davis, California, United States of America.
Makerere University - University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda.
Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America.
Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, United States of America.



Pneumonia is an important cause of morbidity and mortality in persons living with human immunodeficiency virus (HIV) infection. How immune activation differs among HIV-infected and HIV-uninfected adults with pneumonia is unknown.


The Inflammation, Aging, Microbes, and Obstructive Lung Disease (I AM OLD) Cohort is a prospective cohort of adults with pneumonia in Uganda. In this cross-sectional analysis, plasma was collected at pneumonia presentation to measure the following 12 biomarkers: interleukin 6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2), high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, soluble CD27 (sCD27), interferon gamma-inducible protein 10 (IP-10), soluble CD14 (sCD14), soluble CD163 (sCD163), hyaluronan, and intestinal fatty acid binding protein. We asked whether biomarker levels differed between HIV-infected and HIV-uninfected participants, and whether higher levels of these biomarkers were associated with mortality.


One hundred seventy-three participants were enrolled. Fifty-three percent were HIV-infected. Eight plasma biomarkers-sTNFR-1, sTNFR-2, hsCRP, D-dimer, sCD27, IP-10, sCD14, and hyaluronan-were higher among participants with HIV infection, after adjustment for pneumonia severity. Higher levels of 8 biomarkers-IL-6, sTNFR-1, sTNFR-2, hsCRP, IP-10, sCD14, sCD163, and hyaluronan-were associated with increased 2-month mortality.


As in other clinical contexts, HIV infection is associated with a greater degree of immune activation among Ugandan adults with pneumonia. Some of these are also associated with short-term mortality. Further study is needed to explore whether these biomarkers might predict poor long-term outcomes-such as the development of obstructive lung disease-in patients with HIV who have recovered from pneumonia.

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